Harm Reduction

AS we slowly move back to our normal lives even with the virus still very much a threat, public health experts are now more openly talking about ways of mitigating risks of infection other than reverting to lockdowns.

Epidemiologists call this harm reduction. It refers to public health tools and practices that acknowledges risk levels vary by person and setting. As such, solutions should be tailored for those individual scenarios — meant to lessen danger rather than expecting universal compliance to rigid guidance.

With the coronavirus, harm reduction techniques include convincing people to wear masks for the riskiest scenarios, such as crowded spaces, but relaxing those guidelines in places where people can stay at safe distances, such as parks.

Countries like New Zealand, South Korea, and Taiwan have successfully beat back the coronavirus with harm reduction techniques.

More than half a dozen epidemiologists, virologists, and psychologists contacted by National Geographic agree. They said struggling governments can win their COVID-19 wars — and perhaps avoid further lockdowns — through more unified planning and messaging, steeped with harm reduction. They say much of America’s inabilities to control COVID-19 stem from humans ignoring our essential advantages over the virus: communication, cooperation, and compromise.

“We were stuck in this false binary between staying at home indefinitely and going back to business as usual,” Julia Marcus, an epidemiologist and professor at Harvard Medical School in Boston, Massachusetts told National Geographic. She pushed for expanding harm reduction during this crisis.

“Risk isn’t binary, and we can’t expect people to stay home forever, to abstain from social contact forever.”

Jeffrey Shaman, an epidemiologist at Columbia University’s Mailman School of Public Health, agrees.

“The countries that have succeeded have been the ones that have had real political and public will.”

“When there’s an absence of consistent messaging from authorities, many rumors and conspiracy theories can fill the void, and that makes it very difficult for people to figure out what it is that they should do,” Roxane Cohen Silver of UC Irvine told NatGeo.

According to NatGeo, none of these experts believe the COVID-19 war is lost, but government leaders, news media, scientists, and the general public need to shift their mindsets and messaging, because if the virus is victorious, the devastation will be several times worse than what we’re seeing now.

NatGeo observed that “the virus still has abundant room to keep spreading. But harm reduction can help stop that from happening.”

One example of harm reduction is mask wearing. Masks protect everyone from the coronavirus — including the person wearing it. But at least in the US, wearing masks to prevent the spread of COVID-19 has become a political issue, thanks to Donald Trump.
It also doesn’t help that the messaging on mask wearing is garbled so that people are confused.

The Centers for Disease Control and Prevention (CDC) recently updated its “considerations for wearing a face mask”: people should wear cloth face coverings in public settings when they’re around people outside of their home, especially when it’s hard to maintain social distancing.

“Cloth face coverings are recommended as a simple barrier to help prevent respiratory droplets from traveling into the air and onto other people when the person wearing the cloth face covering coughs, sneezes, talks or raises their voice. This is called source control,” the CDC says.

“This recommendation is based on what we know about the role respiratory droplets play in the spread of the virus that causes COVID-19, paired with emerging evidence from clinical and laboratory studies that shows cloth face coverings reduce the spray of droplets when worn over the nose and mouth.”

The WHO didn’t initially recommend wearing masks. Then it accepted the practice primarily to prevent the wearer from spreading the infection. The good news is, there is also now emerging evidence it can protect those wearing it too.

One study published in the journal Health Affairs analyzed the spread of COVID-19 before and after masks were required in 15 states and Washington, DC. The study found that there was a slowdown in the spread of the virus in areas where masks were required, and the slower spread became more obvious over time.

And there is the case in Missouri where two hairstylists worked on 140 clients when they were sick with COVID-19. Everyone wore masks and none of those clients tested positive for the virus.

Experts interviewed by NatGeo observed that since the beginning of its outbreak, the US has relied on two options: mitigation via draconian stay-at-home orders, and containment of the virus’s spread via testing, self-isolation, and contact tracing.

This dual strategy, the NatGeo article pointed out, “is a bit like using either a chainsaw or a scalpel to build Ikea furniture. It isn’t flexible enough to adapt to the ever-surprising coronavirus, and it’s easily derailed by misinformation…

“The world has made huge strides in understanding the coronavirus, but these conclusions take time. Scientists went from being unsure about face masks to fully supporting them in a few months.

“Their mindsets are also shifting on a ‘second wave’ — a concept originally borrowed from the history of influenza pandemics. From an epidemiological perspective, true waves will dissipate on their own without much human intervention, but the coronavirus is not following that traditional pattern.”

“I don’t see this as a wave anymore. Waves are outdated. We have peaks and valleys,” one expert told NatGeo.

Flaws in messaging are threatening progress in the COVID response.

“The bottom line is, it really is about leadership,” says Aileen Marty, a professor at Florida International University who has served as an infectious disease advisor on the local, national, and international levels. All the experts interviewed by NatGeo agreed on this point.

Back here at home, there is no credible leader in our COVID response… not the health secretary… not the generals… not the President. And that’s the crux of our problem. We are fighting a war without a general we can bet our lives on.

As always, we muddle through our problems. Bahala na. Makakaraos din. (Philstar.com)

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